Thoughts and opinions on airways and resuscitation science

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No European consensus – cricoid pressure during RSI

Cricoid pressure was first described by Brian Arthur Sellick in 1961. Since then, it has been an integral component of Rapid Sequence Induction (RSI) in the UK.

The merits of cricoid pressure have been the subject of lively debate for some time, since it is not entirely clear it provides any benefit. In addition, use of cricoid pressure has implications for tracheal intubation and insertion of supraglottic airways. It can also be poorly taught and poorly applied, leaving it unclear whether any issues are due to limitations with the technique itself, inadequate training, or it simply being too difficult to apply it correctly on a consistent basis even when well trained. However, in the 4th UK National Audit Project (NAP4), ‘Major complications of airway management in the UK’, there were no cases where cricoid force was reported as leading to major complications.

96% of those surveyed from the UK confirmed they used cricoid pressure for RSI. No surprises there. The surprise was this was not replicated with the anaesthetists from Austria and Switzerland. Only 52% from Austria and 30% from Switzerland confirmed they used cricoid pressure for RSI. In addition, 40% of the Austrian anaesthetists and 49% of the Swiss replied they never used cricoid pressure.

Of course, the authors of this survey confirmed the limitations of their results, and expressed the hope that a large multi-national European study would be conducted to establish a broader picture of airway management habits in Europe.

So is the UK the last bastion of cricoid pressure in Europe? Looks like we will have to wait for the above mentioned survey to find out.